COVID-19 Specimen Collection and Testing

COVID-19 Specimen Collection and Testing

How to code Medicare Part B claims for reimbursement.

The American Medical Association (AMA) released a new proprietary laboratory analysis (PLA) code for novel coronavirus testing. This code is to be used specifically to report the BioFire® Respiratory Panel 2.1 test.

Let’s Review

With yet another testing code, you may be a little confused as to which code to use for what test. Here’s a rundown of the COVID-19 clinical diagnostic laboratory testing codes, with effective dates and Medicare payment rates.

CodeDescriptorEffective DateMedicare Payment
U0001CDC 2019 novel coronavirus (2019-nCoV) real-time RT-PCR diagnostic panel2/4/20$35.91*
U00022019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC2/4/20$51.31
U0003Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R4/14/20$100
U00042019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R4/14/20$100
U0005Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, CDC or non-CDC, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either HCPCS code u0003 or u0004) SARS-CoV- 2 CMS-2020-01-R2$25
87635Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique3/13/20$51.31
86769Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])4/10/20$42.13
86328Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])4/10/20$45.23
87426nfectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (e.g, SARS-CoV, SARSCoV-2 [COVID-19])$46.23
87428Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B SD: SARSCOV & INF VIR A&B AG IA$73.49
0223UInfectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected$416.78
0224UAntibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed$42.13
0202UInfectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-C0V-2) Qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected$416.78
86408Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer$105.33
0225UInfectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected$416.78
0226USurrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum$42.28
86413Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative. (Effective 9/8/2020)$42.13
87636Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique (effective 10/6/2020)$142.63
87637Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique (effective 10/6/2020)$142.63
87811Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) (effective 10/6/2020)$41.38
0240UInfectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected (effective 10/6/2020)$142.63
0241UInfectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected (effective 10/6/2020)$142.63
updated March 5, 2021

*$35.92 in MAC A/B JH, JL, JN, JS, J8, J15

Update: CMS added the QW modifier to HCPCS Level II U0002 and CPT® 87635. Medicare will allow the use of U0002QW and 87635QW for claims submitted by facilities with a valid, current CLIA certificate of waiver with dates of servcie on or after March 20, 2020. (MLN Matters MM11765)

The effective date for 0202U, per the AMA, is May 20, 2020. The Centers for Medicare & Medicaid Services (CMS) has not weighed in on this new code, as yet. In an earlier FAQ, CMS says to use HCPCS Level II code U0002 for COVID-19 test methods that are not specified by either HCPCS Level II U0001 or CPT® 87635.

See the CPT® Assistant Special Edition May Update for more details on how the AMA intends us to use this new code. See also the CPT® Assistant Special Edition April Update for the AMA’s guidance on using 86328 and 86769. (Note: CPT® Assistant is a paid subscription service. These special editions, however, are free and available for download on the AMA’s website.)

Ordering COVID-19 Diagnostic Lab Tests

During the public health emergency (PHE) for COVID-19, CMS has removed the requirement that certain diagnostic tests are covered only under the order of at treating physician or nonphysician practitioner (NPP). Any healthcare professional authorized to do so under state law may order COVID-19 diagnostic lab tests.

Specimen Collection

Medicare will allow payment for COVID-19 specimen collection billed by qualifying practitioners with CPT® code 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.

Use CPT® 99211 to bill for a COVID-19 symptom and exposure assessment and specimen collection provided by clinical staff incident-to the supervising physician’s or NPP’s services.

UPDATE:
Contact your Medicare Administrative Contractor if you did not include modifier CS when you submitted 99211 so they can reopen and reprocess the claim. CMS will automatically reprocess claims billed for 99211 that were denied due to place of service editing. (MLN Connects June 18, 2020)

Hospital outpatient departments should use HCPCS Level II code C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19])), any specimen source to be paid for COVID-19 symptom assessment and specimen collection.

Note:
HCPCS Level II code C9803 is effective for services provided on or after March 1, 2020. Outpatient Prospective Payment System (OPPS) claims receive on or after May 1, 2020 with coronavirus specimen collection codes G2023 and G2024 will be returned with edit W7062. Resubmit returned claims as a packaged service to include C9803, as appropriate. (MLN Connects May 7, 2020)

Independent labs may bill Medicare for specimen collection fees, transportation fees, and personnel expenses for the duration of the PHE for COVID-19. These fees are billable if the specimen is collected by trained lab personnel from a homebound or non-hospital inpatient. These fees and expenses are not billable if the patient collects their own specimen and a messenger service picks it up.

Price Transparency Requirements

Providers of diagnostic tests for COVID-19 are required to post on their website how much they will charge a patient for the service. This requirement, enacted in section 3202(b) of the CARES Act, is effective for the duration of the PHE for COVID-19. Medicare patients should not be charged a deductible or copay for any COVID-19 test.


Resources:

CMS COVID-19 FAQ on Medicare FFS Billing

https://www.ama-assn.org/system/files/2020-05/coronavirus-long-descriptors.pdf

https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf

CMS MLN Matters 11805

CPB : Online Medical Billing Course

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

9 Responses to “COVID-19 Specimen Collection and Testing”

  1. Imran says:

    Thanks alot Renee for wonderful and knowledgeable detail oriented updated information sharing, I have a question can please favor me
    HCPCS Level II code C9803 is effective for services provided on or after March 1, 2020. Outpatient Prospective Payment System (OPPS) claims receive on or after May 1, 2020 with coronavirus specimen collection codes G2023 and G2024 will be returned with edit W7062. Resubmit returned claims as a packaged service to include C9803, as appropriate. (MLN Connects May 7, 2020)

    Question: we are billing G2023 Commerical Payers Like BCBS, AETNA, UHC and CIGNA are paying for Primary care setting, my question that did commercial insurance payers also returned back paid claims amount, Can we used C9803 for out patient clinics.
    Thanks!
    Imran

  2. Renee Dustman says:

    Commercial payers make their own rules. You will need to check their individual policies.

  3. Barbara Thom says:

    Question: Can C9803 be billed when the patient comes to an outpatient hospital department and is observed by trained personnel while they self-collect a specimen for COVID testing?

  4. Renee Dustman says:

    No. You cannot bill for specimen collection when it is collected by an untrained individual.

  5. Lisa OConnell says:

    Does anyone know what we should bill in in place of the 99211-CS for collecting a specimen in the office to send to an outside lab for testing after 1/1/21? My understanding is the use of CPT code 99211 is being retired with the new E/M coding guidelines going into effect 1/1/21. Thanks

  6. sabrina says:

    So i see alot of medicare denials with 99203, 99214 with mod CS and a z code for the dx why is that ? what can i do to fix this issue

  7. Renee Dustman says:

    Sabrina,
    What is the denial reason code?

  8. Tara says:

    My stepmom went to a cash only place and had a rapid blood draw done that came back positive so they did a swab and she wants to send to insurance for reimbursement. What 2 codes would she sent for these?

  9. Renee Dustman says:

    That depends on the specific tests used and who her insurance is with. Best to ask her insurance company that question.

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